EDITORIAL
THE LANCET
Volume 362, Number 9401
Mexico, 2004: Research for global health and security
The next 12 months will provide the biomedical
research community with its most important
opportunity for a generation to contribute to global
health and security. In November, 2004, an interna-
tional summit on health research will take place in
Mexico City. That meeting will devise a technical
agenda for health research, which will then be
presented to national ministers of health. There is one
overriding question that the summit, organised by
WHO, plans to answer—namely, what research is
needed to reach the Millennium Development Goals
(MDGs) by 2015? In this week’s issue (see p 2083),
WHO’s new director-general, Lee Jong-wook, sets out
his priorities for global health six months after taking
office. It is a bold and ambitious programme.
Creating a thriving international research culture will
be a key to its success.
WHO’s substantive contribution to the Mexico
Summit will be a World Report on Knowledge for
Better Health. The context for its approach will
inevitably be the MDGs. But, as Lee points out, there
must also be a return to the values of Alma Ata—
WHO’s 1978 commitment to primary health care.
The improvement of health systems—bridging the
“know-do” gap—will be WHO’s most difficult
challenge. How will research fit into this work?
At the seventh Global Forum for Health Research,
held in Geneva this month, WHO’s director of
research policy, Tikki Pang, gave some clues. The
agency will argue that research is an investment, not
a cost; that research needs to be defined far more
broadly than the biomedical community convention-
ally believes; that all countries should have a health-
research system that drives health-sector reform; that
research should be applied to improve health equity;
that research must be conducted according to
universal ethical standards; that the results of
research should be accessible to all; and that civil
society has a vital—and so far neglected—part to play
in setting research priorities.
A focus on research and health systems might seem
at odds with WHO’s most far-reaching vertical
disease-control programme since smallpox eradi-
cation—an effort to reach 3 million people living with
HIV-AIDS with anti-retroviral treatment by 2005
(Three by Five). In fact, the two programmes are
complementary, not competing. As Lee has written
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elsewhere, “we know that improving the ability of
countries to distribute the medicines, building health
systems, and training health workers are essential to
Three by Five”. WHO has other priorities too—
notably, improving child survival, launching the final
phase of polio eradication, learning the lessons of
SARS, and continuing its work on tobacco control
and violence prevention. None of these projects will
be sustainable without effective health systems in
place.
Take Nigeria as an example of the challenge at
country level. With an infant mortality rate of
75 deaths per 1000 live births, 70% of its people
living in poverty, weak primary and secondary care
facilities, and desperate shortfalls in human
resources for health, prospects for achieving any of
the MDGs look slim. Meanwhile, Nigeria’s leaders
have had to contend with a well-meaning but
anarchic policy environment. Research has the
potential to draw many disparate initiatives together.
That is the goal of the Mexico Summit: to define
priorities, to put knowledge to its best possible use,
to secure donor commitment, to bring funders
together to unite behind a common agenda, and to
launch concerted initiatives to take this agenda
forward.
Perhaps even more importantly, open research
cultures have enormous non-instrumental value.
They foster a critical rationality that encourages
democratic debate, one of the vital political
components of lasting and peaceful human devel-
opment. This is what makes WHO’s strategy so
revolutionary—a commitment to health-systems
reform has the potential to root health improvement
in a wider pro-democracy movement.
As global poverty worsens, economic inequalities
deepen, and social exclusion increases, it is vital that
health workers everywhere refocus their research
efforts to deliver sustainable systems of care for the
most vulnerable populations of the world. We need a
clear set of priorities—a new set of grand challenges,
perhaps—for research, together with new funding to
support this programme. The next 12 months and
beyond will be the acid test of our collective moral
commitment.
The Lancet
2033